Emergency physicians and clinicians are continually adjusting to the ever changing demands of the emergency department (ED) environment. A sudden influx of patients and a wide range of illnesses and conditions lead to interruptions, multitasking, and the need for quick decision making.
Unfortunately, the fast-paced conditions of the emergency department can lead to alert fatigue, burnout, and medical errors. Creating a work environment that sets clinicians up for success can help mitigate some of these negative effects and outcomes caused by chaos in the ED. Here are three steps to a better workplace for emergency clinicians.
1. Create Efficient Workstations
A survey of emergency medicine providers found that a comfortable and efficient workspace was the number one improvement providers would like to see when it came to their work environment. While workspaces differ from facility to facility, it’s best to have a quiet area for clinicians to complete documentation and paperwork.
The authors of an ACEP Now article suggest the following changes to make provider workstations more efficient and comfortable:
- Dedicated desks for physicians
- Ergonomic and adjustable seating
- Climate control
- Variable lighting
- Snacks and drinks allowed
- Noise-absorbing surfaces
2. Reduce Interruptions When Possible
The second top improvement suggested by emergency providers was a decrease in the amount of interruptions through use of things like a desktop messenger system or HIPAA-compliant phone app for texting where a provider could check messages when they come to a stopping point in other important tasks.
Emergency physicians are interrupted an average of 9.7 times per hour while primary care physicians are typically interrupted 3.9 times per hour on average. The fast pace of an ED can’t be changed, but there are ways to minimize unnecessary interruptions. These may include creating a “no-interruption zone,” monitoring messages less frequently, and identifying critical tasks where interruptions should be limited.
3. Optimize Documentation
About 44 percent of a physician’s shift is spent entering data into electronic health records (EHRs). A busy 10-hour shift requires around 4,000 mouse clicks for common charting functions. One 2019 report on physician burnout, depression, and suicide found that nearly one third of physicians cited EHRs as a main contributor to burnout, making EHR optimization a critical focus when improving the ED work environment.
EHR design and use factors associated with clinician stress include information overload, excessive data entry requirements, and unnecessarily long notes. Many of these could be addressed through vendor improvements, policy changes, and comprehensive training.
The use of scribes has grown with the increase in EHRs. One study found that emergency physician productivity increased by nearly 16 percent when using scribes in EDs. Another study found that scribes positively affected physician satisfaction, charting efficiency, and could be a strategy for reducing burnout. Additionally, scribes are often aspiring clinicians looking to gain experience, making the use of scribes beneficial for all parties involved.
While the fast and sometimes chaotic pace of the emergency department isn’t likely to change, there are things that hospital leadership, technology vendors, and policy makers can do to optimize the ED work environment and help address the burnout associated with the demanding job.
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